[Federal Register Volume 63, Number 134 (Tuesday, July 14, 1998)]
[Rules and Regulations]
[Pages 37778-37779]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-18642]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AI46


Schedule for Rating Disabilities: Cold Injuries

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document amends the Department of Veterans Affairs (VA) 
Schedule for Rating Disabilities by revising the provisions governing 
evaluations for cold injury residuals. The intended effect of this 
amendment is to provide evaluation criteria based on current medical 
knowledge about the long-term effects of cold injury that can be 
applied to any part of the body affected by cold injury.

DATES: Effective Date: This amendment is effective August 13, 1998.

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff (211B), Compensation and Pension Service, Veterans 
Benefits Administration, Department of Veterans Affairs, 810 Vermont 
Avenue NW, Washington, DC 20420, (202) 273-7230.

SUPPLEMENTARY INFORMATION: In the Federal Register of March 28, 1997 
(62 FR 14832), we published a proposal to revise the provisions of VA's 
rating schedule (38 CFR part 4) governing evaluations for frozen feet 
(38 CFR 4.104, diagnostic code 7122). The purpose of the proposal was 
to update the evaluation criteria so that they would be consistent with 
current medical knowledge and encompass the broad range of residuals 
now known to result from cold injuries. We proposed to retitle the 
diagnostic code from residuals of frozen feet to residuals of cold 
injury, to indicate that body parts other than the feet could be 
included. We invited interested persons to submit written comments on 
the proposal.
    As part of a final rule published in the Federal Register of 
December 11, 1997 (62 FR 65207), which revised the cardiovascular 
portion of the rating schedule (38 CFR 4.104), we adopted the revision 
proposed on March 28, 1997, with only minor changes. However, we had 
received comments from the Disabled American Veterans and two 
interested individuals in response to the March 28, 1997, notice of 
proposed rulemaking. This document responds to those comments and 
further revises the rating schedule provisions governing evaluations 
for cold injury residuals.
    One commenter suggested that in rating decisions we change our 
method of ``coding'' disabilities associated with cold injury in order 
to identify the body system or specific body part affected, whether the 
affected body part is on the left or right side, and the percentage 
evaluation for each affected body part.
    While the information the commenter asks us to include is part of 
the written rating decision, that information is not, nor does it need 
to be, reflected by the diagnostic code. The purpose of diagnostic 
codes is merely to identify disabilities for statistical purposes. 
Diagnostic codes are numbers assigned to each condition listed in the 
Schedule for Rating Disabilities. Citation to a diagnostic code in a 
rating decision identifies the rating criteria used to determine the 
evaluation assigned to a particular disability and facilitates VA 
statistical analysis. See 38 CFR 4.27. Adopting the commenter's 
suggestion would have no substantive effect on veterans' disability 
ratings. We therefore make no change in response to this comment.
    Another commenter submitted a copy of a 1951 article entitled Cold 
Injuries in Korea During Winter of 1950-51 by Lt. Col. K. D. Orr, M.C., 
and Capt. D. C. Fainer, M.C. The commenter maintains that the study 
reflected in the article, although flawed, is the basis of most 
thinking regarding cold injuries and has been used to miseducate 
doctors. The commenter suggested that, rather than focusing on 
``frostbite,'' we take into account the impact of extreme cold on 
internal organs and define cold injury to include a broad range of 
conditions, including cardiovascular and respiratory conditions, which 
he contends are the long-term residuals of hypothermia.
    There has been considerable research on cold injuries since 1951, 
when the article to which the commenter refers was published. Medical 
information reviewed in developing the Veterans Health Administration 
Information Letter (IL 10-96-030, December 31, 1996) concerning the 
care and examination of veterans with late effects of cold injuries was 
the medical basis for our revision of the evaluation criteria for 
frostbite. The 1951 Orr-Fainer article was not among the authorities 
cited in the information letter.
    Another commenter stated that VA's Adjudication Procedures Manual, 
M21-1, Part VI, para. 11.20, mentions other signs and symptoms, such as 
joint pain and stiffness, weakness of hands or feet, Raynaud's 
phenomenon, and vascular insufficiency, that may represent chronic 
effects of cold injury. He recommended that we include all of these 
conditions in the evaluation criteria for cold injury (diagnostic code 
7122) so that the criteria are as comprehensive as possible and do not 
omit any symptoms that could be attributed to cold injuries.
    Simply because a condition could be the result of cold injury does 
not mean that it is the result of cold injury in a given claim. All of 
the conditions mentioned have other possible etiologies, and it will 
require a medical determination in each case to establish whether a 
condition claimed as a residual of a cold injury is the residual of a 
cold injury. Furthermore, there are so many conditions which could be 
residuals of cold injury, that should we attempt to provide a 
comprehensive list, we might inadvertently omit conditions that 
individual veterans might suffer as a result of cold injury. Some of 
the conditions mentioned by the commenter, e.g., Raynaud's phenomenon, 
might well warrant higher evaluations in their own right than the 
maximum evaluation of 30 percent allowed under diagnostic code 7122. 
Therefore, rather than including those conditions in the evaluation 
criteria for cold injuries, we have revised note (1) to indicate that 
such conditions may be evaluated separately unless they are used to 
support an evaluation under diagnostic code 7122.
    The same commenter suggested that, since pain is one of the 
evaluation criteria for cold injury residuals, including arthralgia 
(joint pain) as well is redundant.
    Since the medical concept that arthralgia may result from cold 
injury is relatively new, we believe it is important to specify that 
symptom in the evaluation criteria along with the less specific symptom 
of pain.

[[Page 37779]]

Nevertheless, we have revised that portion of the criteria to clarify 
that arthralgia is but one type of pain that will satisfy that 
evaluation criterion.
    We have made several nonsubstantive technical corrections.
    VA appreciates the comments submitted in response to the proposed 
rule. Based on the rationales presented in the March 28, 1997, notice 
of proposed rulemaking and the December 11, 1997, final rule that 
effected the proposed revision, we affirm the revision adopted in that 
final rule, except for the changes made in this final rule for the 
reasons explained above.
    The Secretary hereby certifies that this final rule will not have a 
significant economic impact on a substantial number of small entities 
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The reason for this certification is that this final rule will not 
directly affect any small entities. Only VA beneficiaries will be 
directly affected. Therefore, pursuant to 5 U.S.C. 605(b), this final 
rule is exempt from the initial and final regulatory flexibility 
analysis requirements of sections 603 and 604.
    This final rule has been reviewed by the Office of Management and 
Budget under the provisions of Executive Order 12866, Regulatory 
Planning and Review, dated September 30, 1993.
    The Catalog of Federal Domestic Assistance program numbers are 
64.104 and 64.109.

List of Subjects in 38 CFR Part 4

    Disability benefits, Individuals with disabilities, Pensions, 
Veterans.

    Approved: June 30, 1998.
Togo D. West, Jr.,
Secretary of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 4 is amended 
as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

    1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155, unless otherwise noted.

Subpart B--Disability Ratings

    2. Section 4.104 is amended by revising diagnostic code 7122 to 
read as follows:


Sec. 4.104  Schedule of ratings--cardiovascular system.

* * * * *

                    Diseases of the Arteries and Veins                  
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
                                                                        
                  *        *        *        *        *                 
7122  Cold injury residuals:                                            
  With the following in affected parts:                                 
    Arthralgia or other pain, numbness, or cold sensitivity             
     plus two or more of the following: tissue loss, nail               
     abnormalities, color changes, locally impaired sensation,          
     hyperhidrosis,  X-ray abnormalities (osteoporosis,                 
     subarticular punched out lesions, or osteoarthritis)......       30
    Arthralgia or other pain, numbness, or cold sensitivity             
     plus tissue loss, nail abnormalities, color changes,               
     locally impaired sensation, hyperhidro sis, or X-ray               
     abnormalities (osteoporosis, subarticular punched out              
     lesions, or osteoarthritis)...............................       20
    Arthralgia or other pain, numbness, or cold sensitivity....      10 
------------------------------------------------------------------------
Note (1): Separately evaluate amputations of fingers or toes, and       
  complications such as squamous cell carcinoma at the site of a cold   
  injury scar or peripheral neuropathy, under other diagnostic codes.   
  Separately evaluate other disabilities that have been diagnosed as the
  residual effects of cold injury, such as Raynaud's phenomenon, muscle 
  atrophy, etc., unless they are used to support an evaluation under    
  diagnostic code 7122.                                                 
Note (2): Evaluate each affected part (e.g., hand, foot, ear, nose)     
  separately and combine the ratings in accordance with Secs.  4.25 and 
  4.26.                                                                 
                                                                        
*        *        *        *        *                                   

(Authority: 38 U.S.C. 1155)

[FR Doc. 98-18642 Filed 7-13-98; 8:45 am]
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